Adding or improving fertility benefits at your organization can make a profound difference to your employees struggling to build their families. As of 2020, 61% of employers1 with 500+ employees provide some fertility insurance coverage while 63% of businesses are planning to cover fertility services beyond treatment for infertility.
Small to medium-sized businesses can have a hard enough time providing any health insurance let alone comprehensive fertility benefits. Considering that fertility methods cost tens of thousands of dollars, it’s easy to see the appeal of a company of any size that’s willing to help foot the bill.
In this blog, we’ll go over why you should offer fertility and pregnancy-related benefits, common fertility benefits that employees want covered, and how you can cover the cost with an integrated HRA (GCHRA) or an employee stipend.
Why you should offer fertility benefits
Offering comprehensive fertility benefits is critical for organizations striving to be more inclusive. After all, fertility is no longer just a women’s issue.
Family-planning benefits should meet the needs of employees of any sexual orientation, such as LGBTQ+ employees and male employees, as roughly 50% of fertility issues2 lie with these groups. This benefit should also extend to a single individual as the diagnosis of infertility isn’t bound by marital status.
Additionally, fertility benefits are becoming a top consideration in today’s job market. One study3 found that 68% of employees said they would switch jobs to ensure they had fertility coverage. The same study found that 90% of individuals need coverage for infertility treatment.
Similarly, 60% of women say they would opt for a company offering fertility benefits over a company that didn’t. With these stats, it’s easy to see that fertility insurance coverage can help employers recruit and retain top talent.
Here are four advantages that come from offering fertility insurance:
- Long-term healthcare savings by supporting early fertility care.
- Improved employee morale and company loyalty.
- Inclusive benefits that support all employees of a diverse workforce.
- Enhanced reputation as a family-friendly organization.
Family-building benefits can be a cost-effective way to increase productivity. A benefit that provides clinical oversight throughout an employee’s fertility journey increases the likelihood of a successful pregnancy while decreasing pharmacy costs, neonatal intensive care, and other expensive health-related costs resulting in happier and satisfied employees.
Common fertility benefits that employees want covered
In this labor market, employers are scrambling to offer comprehensive coverage for fertility services as part of their health insurance plan.
According to a ScienceDirect4 article, infertility impacts about 6.7 million people in the U.S. alone and 96 million worldwide. Even an otherwise healthy individual can need access to infertility care.
Ensuring you’re offering the right fertility benefits that employees commonly ask for is an excellent place to start when designing your health benefit.
The six most commonly covered fertility treatments for employees are:
- Fertility preservation coverage, including egg procurement , embryo transfer, and freezing.
- Intrauterine insemination.
- Mental health counseling and resources for those struggling with fertility issues.
- Non-in vitro fertilization (IVF) treatment.
- Diagnostic testing, including for genetic conditions, imaging, and other lab tests.
- Medical treatment services, including fertility drugs, artificial insemination, and surgery.
Remember that family benefits don’t have to be exclusive to medical conditions. Other popular family-friendly benefits include flexible work schedules, paid maternity and paternity leave, adoption assistance, child care, and much more.
Is IVF covered by insurance?
Maternity and infant care are considered essential health benefits under most health insurance plans, but infertility care often isn’t covered. Roughly 1 in 5 women5 have trouble getting pregnant, and IVF has become a popular path to success. But even though demand grows, coverage for fertility care continues to be limited.
According to the National Conference of State Legislatures6, the average IVF cycle can cost between $12,000 to $17,000. With medication and proper prescription drug coverage, the cost can rise to closer to $25,000.
One insurance provider may cover IVF, but not the injections that a covered person may also require. Other plans might only cover a limited number of retrievals per lifetime. And some health benefit plans don’t cover IVF at all—they may just cover diagnostic services.
If you provide traditional group health insurance, your employees aren’t necessarily guaranteed coverage. A Mercer survey7 shows that only 27% of companies with 500+ employees covered IVF services for individuals in 2020. That share is likely much smaller for small and midsize organizations.
If IVF is a priority for many of your employees, you’ll want to provide a health insurance policy that offers as much coverage for these medical conditions as possible.
Remember, just because a medical professional says someone is a candidate for IVF doesn’t mean they’ll be automatically eligible for care—that’ll be up to the plan and network providers.
How to confirm if your insurance covers IVF
If you already have health insurance coverage at your organization, you can check your summary of benefits, or explanation of benefits page, to find out if your insurance policy covers IVF. If you have employees asking about their infertility coverage, they can request the most recent copy from your HR department, benefits specialist, or health insurance company.
If you have little to no access to infertility services, there are ways your employees can advocate treatment for a successful pregnancy:
- They can speak to their fertilization clinic about potential IVF clinical trials.
- They should keep copies of receipts showing they’ve spent money on fertility treatment, diagnostic testing, or other related care. Their financial advisor can determine if they’re able to be classified as “medical” during tax season.
- If you offer a flexible spending account (FSA), health savings account (HSA), or health reimbursement arrangement (HRA), employees can use those funds towards IVF for that year.
- They can research fertility financing options.
While it’s your employees’ responsibility to understand their health benefits, you should be able to point them in the right direction for clarification. Additionally, if a fertility doctor is already treating them, most fertilization clinics have a financial advisor who can also help.
How employers can cover the cost of fertility benefits
Despite a need for infertility services, fertility coverage is inaccessible to many because of the costly treatment. Most fertility assistance services aren’t fully covered by their insurance company.
Some employers get supplemental insurance coverage to fill in gaps in their traditional group insurance health plans to remedy this. But even so, a covered individual will most likely still pay high out-of-pocket costs for fertility treatment depending on the fertilization services needed to have a viable pregnancy.
Luckily, the two options we’ll explain below allow you to offer your employees a well-rounded, personalized fertility coverage without going over your budget.
Your first option is an integrated HRA. An integrated HRA, or group coverage HRA (GCHRA), is a tax-free reimbursement arrangement between an employer and a covered individual to help them pay for out-of-pocket costs that aren’t fully paid for in their group health insurance plan.
With a GCHRA, you set a monthly allowance for your employees to use on healthcare. The allowance you can set is unlimited, so if you’re aiming for top fertility care and benefits, the sky's the limit on how much you can give your employees.
IRS Publication 502 lists many types of coverage of infertility treatment that can be reimbursed with a GCHRA, such as:
- Fertility and ovulation monitors
- Visits to fertility clinics
- Artificial insemination
- Infertility treatment
- Fertility preservation coverage
- Pregnancy tests, diagnostic testing, medical treatment, and much more
Allowances can’t be exceeded, and any unused allowance stays with you when an employee leaves the organization, making a GCHRA an affordable solution to offering infertility benefits while increasing your employees' chances of having a successful pregnancy.
Another additional benefit that can cover your employees’ fertility costs is a health stipend. A health stipend is a fixed sum of money offered to employees to purchase necessary medical services.
Just like an integrated HRA, the amount of money you can offer is unlimited. But with a health stipend, the money is typically added to your employee’s paycheck, making it extra taxable income.
Health stipends are generally easier to administer than HRAs and other health benefit plans. Because you can set up a stipend for anything, they are very flexible to whatever medical treatment your employees need, whether it’s family planning, IVF, adoption, egg retrieval, surrogacy, or child care services.
What’s more, health stipends aren’t subject to the Affordable Care Act’s IRS regulations, so the availability of coverage is quick and easy. Simply put, stipends are the most inclusive option if you’re looking for a truly endless benefit regardless of your employees’ medical history.
Access to fertility care, IVF, and pregnancy-related benefits are no longer considered a nice-to-have insurance option—they’re a must-have benefit for you to support your employees and be recognized as a family-friendly organization. Even in this tight labor market, you can offer top-notch fertility benefits to attract and retain top talent without breaking the bank.
An integrated HRA or a health stipend can provide an all-in-one solution to support a successful pregnancy and fertility benefits at an affordable price. If you think one of these personalized benefit solutions is suitable for your company, contact our team, and we’ll get you on your way!
This article was originally published on March 2, 2022. It was last updated on July 6, 2022.